Provider Demographics
NPI:1548863384
Name:THOMPSON, ADAM GREGORY
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GREGORY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 S STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-9758
Mailing Address - Country:US
Mailing Address - Phone:513-697-4881
Mailing Address - Fax:
Practice Address - Street 1:6632 S STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9758
Practice Address - Country:US
Practice Address - Phone:513-697-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0332880183500000X
OH03328820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist